Provider Demographics
NPI:1417929761
Name:MARQUARDT, R CHRISTOPHER (OD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:CHRISTOPHER
Last Name:MARQUARDT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2910
Mailing Address - Country:US
Mailing Address - Phone:715-848-1246
Mailing Address - Fax:715-842-1660
Practice Address - Street 1:515 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2910
Practice Address - Country:US
Practice Address - Phone:715-848-1246
Practice Address - Fax:715-842-1660
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2446152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38590600Medicaid
WI0343180001Medicare NSC
WI38590600Medicaid
WIU47709Medicare UPIN